居家血壓監測用於管理高血壓之個案報告

Improved Hypertension Control through Home Blood Pressure Monitoring: A Case Report

「2022年中華民國心臟學會及台灣高血壓學會高血壓管理指引」將居家血壓監測(home blood pressure monitoring, HBPM)的作用，從「診斷」進一步擴展至「長期追蹤」的整體高血壓管理過程，並倡議HBPM標準化的「722」方案(“722” principle or protocol)，此建議目前也由衛生福利部「全民健康保險代謝症候群防治計畫」推廣中。

在此個案報告中，我們討論一位37歲男性關於「HBPM用於管理高血壓」並追蹤2.2年的臨床經驗(2022/09/13至2024/11/05)、並提示在上述指引的臨床實踐中常見的一些陷阱，期望臨床醫師與家庭醫師能透過本篇論文協助社會大眾學習高血壓的管理技能。

起始三個週期的HBPM，可確定個案診斷為第二期高血壓(Stage 2, ≥140/90 mmHg)、以及他的基線「722」血壓估計值 > 157/107 mmHg，並促進個案積極管理高血壓。透過定期門診訪視和醫病共享決策(shared decision-making, SDM)，個案學習高血壓的管理（包括非藥物治療、與藥物治療）。經過他的積極管理，從2023/01/10起「722」收縮血壓估計值被降低至通用目標(universal target: < 130 mmHg)，進而自2024/03/12起「722」血壓估計值被穩定地維持在他的自訂目標（身體感覺最舒服：≤ 120/80 mmHg）。

此案例顯示：在定期家庭醫學門診和SDM的支持下，HBPM可幫助病人避免陷阱、並提升高血壓的長期管理品質。作者提議：醫療專業人員(1)協助病人理解、並遵照現行台灣高血壓管理指引的建議；(2)鼓勵病人不僅在高血壓的初步評估和診斷時期、並且在高血壓開始治療後的2-3年內，都持續不斷地每週實踐HBPM，以提升高血壓長期管理的成效。

 

The 2022 Taiwan Society of Cardiology and Taiwan Hypertension Society Guidelines for Hypertension Management expand the role of home blood pressure monitoring (HBPM) to encompass the whole hypertension management process, from diagnosis to long-term follow-up, and advocate the “722” protocol for HBPM standardization, currently promoted by the National Health Insurance Metabolic Syndrome Prevention and Treatment Program of the Ministry of Health and Welfare, Republic of China (Taiwan).

In this case report, we discuss the 2.2-year (September 13, 2022 to November 5, 2024) clinical experience of implementing HBPM for hypertension management in a 37-year-old man and highlight some common pitfalls in the clinical applications of the aforementioned guidelines. We hope this report will help clinicians and family physicians assist the general public in learning hypertension management skills.

The blood pressure (BP) values of the first three cycles of HBPM confirmed the diagnosis of stage 2 hypertension (≥140/90 mmHg) and established his baseline “722” BP estimates at > 157/107 mmHg. These findings motivated the patient to actively engage in managing his hypertension. With regular outpatient visits and shared decision-making (SDM), he learned to self-manage his hypertension through non-pharmacological and pharmacological therapies. Active management enabled the patient to lower his “722” systolic BP estimates to the universal target (< 130 mmHg) by January 10, 2023; furthermore, since March 12, 2024, he has consistently maintained his “722” BP estimates at his self-set target (≤120/80 mmHg, the level at which he feels most comfortable).

This case illustrates that, with the support of regular family medicine outpatient visits and SDM, HBPM can help patients avoid pitfalls and improve the quality of long-term hypertension management. The authors propose that healthcare professionals (1) assist patients in understanding and adhering to the recommendations of the current Taiwan hypertension management guidelines and (2) encourage patients to practice HBPM weekly, not only during the initial evaluation and diagnosis of hypertension but also within 2-3 years after starting treatment, to improve the effectiveness of long-term hypertension management.